Attracting doctors and medical students to rural Vietnam: insights from a Discrete Choice Experiment

Abstract

Persuading medical doctors to work in rural areas is one of the main challenges facing health policy makers, in both developing and developed countries. Discrete choice experiments (DCEs) have increasingly been used to analyze the preferences of health workers, and how they would respond to alternative incentives associated with working in a rural location. Previous DCE studies focusing on the rural recruitment and retention problem have sampled either in-service health workers or students in the final year of their training program. This study is the first to sample both of these groups in the same setting. We carry out a DCE to compare how doctors and final-year medical students in Vietnam value six job attributes, and use the results to simulate the impact of alternative incentive packages on recruitment in rural areas. Results show significant differences between the two groups. The location of workplace (rural or urban) was by far the most important attribute for doctors; for medical students it was long-term education. More surprising, however, was the magnitude of the differences: there were fivefold differences in willingness-to-pay estimates for some job attributes. These differences strongly suggest that policy makers in Vietnam should consider moving away from the current uniform approach to rectifying rural shortages and tailor separate incentive packages to students and doctors. Our results also suggest that future DCE studies should carefully consider the choice of sample if results are to be used for policy making.